Job description
DESCRIPTION
The Precertification Specialist is responsible for obtaining prior authorizations for all procedural orders by successfully completing the authorization process with all commercial payers.
RESPONSIBILITIES
- Review chart documentation to ensure patient meets medical policy guidelines
- Prioritize incoming authorization requests according to urgency
- Obtain authorization via payer website or by phone and follow up regularly on pending cases
- Maintain individual payer files to include up to date requirements needed to successfully obtain authorizations
- Initiate appeals for denied authorizations
- Respond to clinic questions regarding payer medical policy guidelines
- Confirm accuracy of CPT and ICD-10 diagnoses in the procedure order
- Contact patients to discuss authorization status
- Other duties as assigned
KNOWLEDGE, SKILLS, AND ABILITIES
- Knowledge of procedure authorization and its direct impact on the practices revenue cycle
- Understanding of payer medical policy guidelines while utilizing these guidelines to manage authorizations effectively
- Basic understanding of human anatomy, specifically musculoskeletal
- Proficient use of CPT and ICD-10 codes
- Excellent computer skills including Excel, Word, and Internet use
- Detail oriented with above average organizational skills
- Plans and prioritizes to meet deadlines
- Excellent customer service skills; communicates clearly and effectively
- Ability to multitask and remain focused while managing a high-volume, time-sensitive workload
EDUCATION/EXPERIENCE REQUIRED
- High School Diploma or GED
- 2 years medical prior authorization experience preferred
- 2 years experience in a medical related field required
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